=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841923778
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANATREON WILLIAMS LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2022
-----------------------------------------------------
Last Update Date | 07/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 N RUFE SNOW DR
-----------------------------------------------------
City | KELLER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76248-4235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-213-8933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5424 RUFE SNOW DR STE 200
-----------------------------------------------------
City | NORTH RICHLAND HILLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76180-6685
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-213-8933
-----------------------------------------------------
Fax | 682-593-3936
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 103694
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------